Nclex PRN Cards

Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language? A. Rely on nonverbal communication. B. Select symbolic pictures as aids. C. Speak in universal phrases. D. Use the services of an interpreter.

Answer D An interpreter will enable the nurse to better assess the client's problems and concerns. Nonverbal communication is important; however for the nurse to fully determine the client's problems and concerns, the assistance of an interpreter is essential. The use of symbolic pictures and universal phrases may assist the nurse in understanding the basic needs of the client; however these are insufficient to assess the client with a psychiatric problem.

A 45-year-old woman with a history of depression tells a nurse in her doctor's office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the client's sexual difficulty? A. Education and work history B. Medication used C. Physical health status D. Quality of spousal relationship

Answer: A Education and work history would have the least significance in relation to the client's sexual problem. Age, health status, physical attributes and relationship issues have great influence on sexual expression.

School phobia is usually treated by: A. Returning the child to the school immediately with family support. B. Calmly explaining why attendance in school is necessary C. Allowing the child to enter the school before the other children D. Allowing the parent to accompany the child in the classroom

Answer: A Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. Thiswill not help the child overcome the fear

The nurse collecting family assessment data asks. "Who is in your family and where do they live?" which of the following is the nurse attempting o identify? a. Boundaries b. Ethnicity c. Relationships d. Triangles

Answer: A Family boundaries are parameters that define who is inside and outside the system. The best method of obtaining this information is asking the family directly who they consider to be members. The question asked by the nurse would not elicit information about the family's ethnicity or culture, nor does it address the nature of the family relationship.

The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is: A. Sexual desire disorder B. Sexual arousal Disorder C. Orgasm Disorder D. Sexual Pain Disorder

Answer: A Has little or no sexual desire or has distaste for sex. B. Failure to maintain the physiologic requirements for sexual intercourse. C. Persistent and recurrent inability to achieve an orgasm. D. Also called dyspareunia. Individuals with this disorder suffer genital pain before, during and after sexual intercourse.

What is the medical term for blood in the urine? A. Hematuria B. Heomstasis C. Uremia D. Hematocrit

Answer: A Hematuria

The nurse would expect a client with early Alzheimer's disease to have problems with: A. Balancing a checkbook. B. Self-care measures. C. Relating to family members. D. Remembering his own name

Answer: A In the early stage of Alzheimer's disease, complex tasks (such as balancing a checkbook) would be the first cognitive deficit to occur. The loss of self-care ability, problems with relating to family members, and difficulty remembering one's own name are all areas of cognitive decline that occur later in the disease process.

The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis: A. hopelessness B. altered parenting role C. altered family process D. ineffective coping

Answer: B Altered parenting role refers to the inability to create an environment that promotes optimum growth and development of the child. This is reflected in the parent's inability to care for the child. A. This refers to lack of choices or inability to mobilize one's resources. C. Refers to change in family relationship and function. D. Ineffective coping is the inability to form valid appraisal of the stressor or inability to use available resources

The nurse understands that if a client continues to be dependent on heroin throughout her pregnancy, her baby will be at high risk for: A. Mental retardation. B. Heroin dependence. C. Addiction in adulthood. D. Psychological disturbances.

Answer: B Babies born to heroin-dependent women are also heroin-dependent and need to go through withdrawal. There is no evidence to support any of the remaining answer choices.

What is the medical term for headache? A. Migraine B. Cephalgia C. Cyanosis D. Concussion

Answer: B Cephalgia

The nurse correctly teaches a client taking the benzodiazepine oxazepam (Serax) to avoid excessive intake of: A. Cheese B. Coffee C. Sugar D. Shellfish

Answer: B Coffee contains caffeine, which has a stimulating effect on the central nervous system that will counteract the effect of the antianxiety medication oxazepam. None of the remaining foods is contraindicated.

What is the medical term for the enlargement of a finger or toe? A. Diaphysis B. Dactylomegaly C. Ankylosis D. Kyphosis

Answer: B Dactylomegaly

Which of the following factors most influence definitions of mental illness and mental health and must be taken into consideration when developing a nursing care plan for a client? A. Psychiatrists' experiences with clients. B. Cultural and societal attitudes and expectations. C. Modern scientific research reports. D. The findings of the human genome project.

Answer: B Definitions of mental health and mental illness can change as culture and society change their attitudes and expectations.

The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol abuse. The primary function of this group is to: A. Encourage the use of a 12-step program. B. Help members maintain sobriety. C. Provide fellowship among members. D. Teach positive coping mechanisms.

Answer: B The primary purpose of Alcoholics Anonymous is to help members achieve and maintain sobriety. Although each of the remaining answer choices may be an outcome of attendance at Alcoholics Anonymous, the primary purpose is directed toward sobriety of members.

A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying

Answer: B These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder

When providing family therapy, the nurse analyzes the functioning of healthy family systems. Which situations would not increase stress on a healthy family system? A. An adolescent's going away to college B. The birth of a child C. The death of a grandparent D. Parental disagreement

Answer: D In a functional family, parents typically do not agree on all issues and problems. Open discussion of thoughts and feeling is healthy, and parental disagreement should not cause system stress. The remaining answer choices are life transitions that are expected to increase family stress.

The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli. B. Ritualistic behaviors C. Preference for inanimate objects. D. Serious violations of age related norms.

Answer: D This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder.

Situation: A 30 year old male employee frequently complains of low back pain that leads to frequent absences from work. Consultation and tests reveal negative results. The client has which somatoform disorder? A. Somatization Disorder B. Hypochondriaisis C. Conversion Disorder D. Somatoform Pain Disorder

Answer: D This is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.

What does the prefix ab- mean? A: with B: away from C: without D: towards

Answer B The prefix means away from. Abduction- moving away from the body

What is the correct medical term for scraping away of the skin or mucous membrane by friction? A. Contusion B. Bullae C. Carbuncle D. Abrasion

Answer D Abrasion

The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? A. "I guess you're worried about something, aren't you? B. "Can I get you some medication to help calm you?" C. "Have you been pacing for a long time?" D. "I notice that you're pacing. How are you feeling?"

Answer D By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety. In option A, the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a "yes" or "no" response, which is not therapeutic. In option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a "yes" or "no" response, avoids focusing on the client's anxiety, which is the reason for his pacing.

The nurse explains to a mental health care technician that a client's obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? A. Behavioral theory B. Cognitive theory C. Interpersonal theory D. Psychoanalytic theory

Answer D Psychoanalytic is based on Freud's beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other. Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptomatic behavior.

A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is most therapeutic? A. Accepting the client's obsessive-compulsive behaviors B. Challenging the client's obsessive-compulsive behaviors C. Preventing the client's obsessive-compulsive behaviors D. Rejecting the client's obsessive-compulsive behaviors

Answer: A A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client's attempt to feel secure is therapeutic. When a specific treatment plan is developed, other nursing responses may also be acceptable. The remaining answer choices will increase the client's anxiety and therefore are inappropriate.

A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the client's delusional perceptions would the nurse establish? A. The client will demonstrate realistic interpretation of daily events in the unit. B. The client will perform daily hygiene and grooming without assistance. C. The client will take prescribed medications without difficulty. D. The client will participate in unit activities.

Answer: A A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspects of the environment as plotting against him. The desired outcome for someone with delusional perceptions would be to have a realistic interpretation of daily events. The client with a distorted perception of the environment would not necessarily have impairments affecting hygiene and grooming skills. Although taking medications and participating in unit activities may be appropriate outcomes for nursing intervention, these responses are not related to client perceptions.

Which neurotransmitter has been implicated in the development of Alzheimer's disease? A. Acetylcholine B. Dopamine C. Epinephrine D. Serotonin

Answer: A A relative deficiency of acetylcholine is associated with this disorder. The drugs used in the early stages of Alzheimer's disease will act to increase available acetylcholine in the brain. The remaining neurotransmitters have not been implicated in Alzheimer's disease.

Which of the following describes the role of a technician? A. Administers medications to a schizophrenic patient. B. The nurse feeds and bathes a catatonic client C. Coordinates diverse aspects of care rendered to the patient D. Disseminates information about alcohol and its effects.

Answer: A Administration of medications and treatments, assessment, documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D. Role as a teacher.

A client taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructed by the nurse to avoid which foods and beverages? A. Aged cheese and red wine B. Milk and green, leaf vegetables C. Carbonated beverages and tomato products D. Lean red meats and fruit juices

Answer: A Aged cheese and red wines contain the substance tyramine which, when taken with an MAOI, can precipitate a hypertensive crisis. The other foods and beverages do not contain significant amounts of tyramine and, therefore, are not restricted.

Group members have worked very hard, and the nurse reminds them that termination is approaching. Termination is considered successful if group members: A. Decide to continue. B. Elevate group progress C. Focus on positive experience D. Stop attending prior to termination.

Answer: A As the group progresses into the working phase, group members assume more responsibility for the group. The leader becomes more of a facilitator. Comments about behavior in a group are indicators that the group is active and involved. The remaining answer choices would indicate the group progress has not advanced to the working phase.

What is the medical term for the removal of the gallbladder? A. Cholecystectomy B. Cholangiography C. Choledochectomy D. Cystectomy

Answer: A Cholecystectomy

Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital. When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. provide as much structure as possible for the child B. ignore the child's overactivity. C. encourage the child to engage in any play activity to dissipate energy D. remove the child from the classroom when disruptive behavior occurs

Answer: A Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non -confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure.

What is the medical term for painful menstruation? A. Dysmenorrhea B. Dyspareunia C. Amenorrhea D. Hypermenorrhea

Answer: A Dysmenorrhea

A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful? A. The parents reinforce increased decision making by the client. B. The parents clearly verbalize their expectations for the client. C. The client verbalizes that family meals are now enjoyable. D. The client tells her parents about feelings of low-self-esteem.

Answer: A One of the core issues concerning the family of a client with anorexia is control. The family's acceptance of the client's ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addressed in these responses.

What would be the best approach for a wife who is still living with her abusive husband? A. "Here's the number of a crisis center that you can call for help ." B. "Its best to leave your husband." C. "Did you discuss this with your family?" D. " Why do you allow yourself to be treated this way"

Answer: A Protection is a priority concern in abuse. Help the victim to develop a plan to ensure safety. B. Do not give advice to leave the abuser. Making decisions for the victim further erodes her esteem. However discuss options available. C. The victim tends to isolate from friends and family. D. This is judgmental. Avoid in anyway implying that she is at fault.

Liza says, "Give me 10 minutes to recall the name of our college professor who failed many students in our anatomy class." She is operating on her: A Subconscious B. Conscious C. Unconscious D. Ego

Answer: A Subconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily. B. This functions when one is awake. One is aware of his thoughts, feelings actions and what is going on in the environment. C. The largest potion of the mind that contains the memories of one's past particularly the unpleasant. It is difficult to recall the unconscious content. D. The conscious self that deals and tests reality.

What is the medical term for above the pubic bones? A. Suprapubic B. Inferiopubic C. Perineum D. Transperineal

Answer: A Suprapubic

The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught except: A. overprotection of the child B. patience, routine and repetition C. assisting the parents set realistic goals D. giving reasonable compliments

Answer: A The child with mental retardation should not be overprotected but need protection from injury and the teasing of other children. B,C, and D Children with mental retardation have learning difficulty. They should be taught with patience and repetition, start from simple to complex, use visuals and compliment them for motivation. Realistic expectations should be set and optimize their capability.

Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted: A. increased attention span and concentration B. increase in appetite C. sleepiness and lethargy D. bradycardia and diarrhea

Answer: A The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.

Situation: In a home visit done by the nurse, she suspects that the wife and her child are victims of abuse. Which of the following is the most appropriate for the nurse to ask? A. "Are you being threatened or hurt by your partner? B. "Are you frightened of you partner" C. "Is something bothering you?" D. "What happens when you and your partner argue?"

Answer: A The nurse validates her observation by asking simple, direct question. This also shows empathy. B, C, and D are indirect questions which may not lead to the discussion of abuse.

What would be the best response to the client's repeated complaints of pain: A. "I know the feeling is real tests revealed negative results." B. "I think you're exaggerating things a little bit." C. "Try to forget this feeling and have activities to take it off your mind" D. "So tell me more about the pain"

Answer: A Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client's feelings. D. Giving undue attention to the physical symptom reinforces the complaint.

A client with panic disorder experiences an acute attack while the nurse is completing an admission assessment. List the following interventions according to their level of priority. A. Remain with the client. B. Encourage physical activity. C. Encourage low, deep breathing. D. Reduce external stimuli. E. Teach coping measures.

Answer: ADCBE The nurse should remain with the client to provide support and promote safety. Reducing external stimuli, including dimming lights and avoiding crowded areas, will help decrease anxiety. Encouraging the client to use slow, deep breathing will help promote the body's relaxation response, thereby interrupting stimulation from the autonomic nervous system. Encouraging physical activity will help him to release energy resulting from the heightened anxiety state; this should be done only after the client has brought his breathing under control. Teaching coping measures will help the client learn to handle anxiety; however, this can only be accomplished when the client's panic has dissipated and he is better able to focus.

While reviewing the charts of assigned clients with physical illness as well as mental illness, you notice that the psychiatrist has listed the five axes of the current diagnostic and statistical manual published by the American Psychiatric Association and has filled in information on each axis. Which axis would you find the general medical conditions listed? A. Axis II B. Axis III C. Axis I D. Axis IV

Answer: B Following is the DSM's five-axis diagnosis system: Axis I Clinical Psychiatric Disorders Axis II Personality Disorders/Mental Retardation Axis III General Medical Conditions Axis IV Psychosocial and Environmental Problems Axis V Global Assessment of Functioning You can see that General Medical Conditions is listed on Axis III.

Which comment about a 3 year old child if made by the parent may indicate child abuse? A. "Once my child is toilet trained, I can still expect her to have some" B. "When I tell my child to do something once, I don't expect to have to tell" C. "My child is expected to try to do things such as, dress and feed." D. "My 3 year old loves to say NO."

Answer: B Abusive parents tend to have unrealistic expectations on the child. A,B and C are realistic expectations on a 3 year old.

According to the family systems theory, which of the following best describes the process of differentiation? a. Cooperative action among members of the family b. Development of autonomy within the family c. Incongruent massages wherein the recipient is a victim d. Maintenance of system continuity or equilibrium

Answer: B Differentiation is the process of becoming an individual developing autonomy while staying in contact with the family system. Cooperative action among family members does not refer to differentiation, although individuals who have a high level of differentiation would be able to accomplish cooperative action. Incongruent messages in which the recipient is a victim describe double-bind communication. Maintenance of system continuity or equilibrium is homeostasis.

Freud explains anxiety as: A. Strives to gratify the needs for satisfaction and security B. Conflict between id and superego C. A hypothalamic-pituitary-adrenal reaction to stress D. A conditioned response to stressors

Answer: B Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model.

Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders observe that the group members are anxious and look to the leaders for answers. Which phase of development is this group in? A. Conflict resolution phase B. Initiation phase C. Working phase D. Termination phase

Answer: B Increased anxiety and uncertainly characterize the initiation phase in group therapy. Group members are more self-reliant during the working and termination phases.

1. Mental health is defined as: A. The ability to distinguish what is real from what is not. B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation D. Absence of mental illness

Answer: B Mental health is a state of emotional and psychosocial well being. A mentally healthy individual is self aware and self directive, has the ability to solve problems, can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to love and work and sets goals and realistic limits. A. This describes the ego function reality testing. C. This is the definition of Mental Health and Psychiatric Nursing. D. Mental health is not just the absence of mental illness.

A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. Which medication would cause the nurse to express concern and therefore initiate further teaching? A. Acetaminophen (Tylenol) B. Diphenhydramine (Benadryl) C. Furosemide (Lasix) D. Isosorbide dinitrate (Isordil)

Answer: B Over-the-counter medications used for allergies and cold symptoms are contraindicated because they will increase the sympathomimetic effects of MAOIs, possibly causing a hypertensive crisis. None of the remaining medications will increase the sympathomimetic response and, therefore, are not contraindicated.

The school nurse is wondering why parents of a child who has symptoms of a mental disorder refuse to take the child to a psychiatrist, a psychologist, or a psychiatric clinical nurse specialist. Which of the following reasons is most likely for the parent's refusal, and suggests the parents need the nurse to provide some education? A. There is a fear that the child will be harmed by treatment providers. B. The stigma of mental illness causes the parents to be resistant. C. There is a fear of the child having to take psychotropic medication. D. The clients are abusive and don't want anyone to find out.

Answer: B People can feel so ashamed of having a mental illness or their child having a mental illness, that they refuse to get treatment. People running for political office have dropped out of politics when it became known that they had been treated for mental illness. Even physicians sometimes hesitate to give their patients the diagnosis of a mental disorder for fear that the patients will be "labeled" and treated badly as a result. It is true that people with mental disorders have symptoms and impairment in their functioning. However, these disorders are treatable.

An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which of the following behaviors would the nurse assess? A. Restlessness, short attention span, hyperactivity B. Physical aggressiveness, low stress tolerance disregard for the rights of others C. Deterioration in social functioning, excessive anxiety and worry, bizarre behavior D. Sadness, poor appetite and sleeplessness, loss of interest in activities

Answer: B Physical aggressiveness, low stress tolerance, and a disregard for the rights of others are common behaviors in clients with conduct disorders. Restlessness, short attention span, and hyperactivity are typical behaviors in a client with attention deficit hyperactivity disorder. Deterioration in social functioning, excessive anxiety and worry and bizarre behaviors are typical in schizophrenic disorders. Sadness, poor appetite, sleeplessness, and loss of interest in activities are behaviors commonly seen in depressive disorders.

The nurse understands that electroconvulsive therapy is primary used in psychiatric care for the treatment of: A. Anxiety disorders. B. Depression. C. Mania. D. Schizophrenia.

Answer: B The onset of action of the SSRI antidepressant paroxetine occurs around 3 to 4 weeks after drug therapy begins. Therefore, a client will seldom notice improvement before this time. Continuing to take the drug is important for this client.

The parents of a young man with schizophrenia express feelings of responsibility and guilt for their son's problems. How can the nurse best educate the family? a. Acknowledge the parent's responsibility. b. Explain the biological nature of schizophrenia. c. Refer the family to a support group d. Teach the parents various ways they must change.

Answer: B The parents are feeling responsible and this inappropriate self-blame can be limited by supplying them with the facts about the biologic basis of schizophrenia. Acknowledging the patient's responsibility is neither accurate nor helpful to the parents and would only reinforce their feelings of guilt. Support groups are useful; however, the nurse needs to handle the parents' self-blame directly instead of making a referral for this problem. Teaching the parents various ways to change would reinforce the parental assumption of blame; although parents can learn about schizophrenia and what is helpful and not helpful, the approach suggested in this option implies the parents' behavior is at fault.

A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processes related to difficulty concentrating, secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client? A. The client verbalizes feelings directly during treatment. B. The client verbalizes positive "self" statement. C. The client speaks in coherent sentences. D. The client reports feelings calmer.

Answer: C A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one topic to another. Speaking in coherent sentences is an indicator that the client's concentration has improved and his thoughts are no longer racing. The remaining options do not relate directly to the stated nursing diagnosis.

Which client outcome is most appropriately achieved in a community approach setting in psychiatric nursing? A. The client performs activities of daily living and learns about crafts. B. The client's is able to prevent aggressive behavior and monitors his use of medications. C. The client demonstrates self-reliance and social adaptation. D. The client experience experiences anxiety relief and learns about his symptoms.

Answer: C A therapeutic community is designed to help individuals assume responsibility for themselves, to learn how to respect and communicate with others, and to interact in a positive manner. The remaining answer choices may be outcomes of psychiatric treatment, but the use of a therapeutic community approach is concerned with promotion of self-reliance and cooperative adaptation to being with others.

Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should: A. Assess skin color and sclera B. Assess the radial pulse C. Take the client's blood pressure D. Ask the client to void

Answer: C Because chlorpromazine (Thorazine) can cause a significant hypotensive effect (and possible client injury), the nurse must assess the client's blood pressure (lying, sitting, and standing) before administering this drug. If the client had taken the drug previously, the nurse would also need to assess the skin color and sclera for signs of jaundice, a possible drug side affect; however, based on the information given here, there is no evidence that the client has received chlorpromazine before. Although the drug can cause urine retention, asking the client to avoid will not alter this anticholinergic effect.

The following statements describe somatoform disorders: A. Physical symptoms are explained by organic causes B. It is a voluntary expression of psychological conflicts C. Expression of conflicts through bodily symptoms D. Management entails a specific medical treatment

Answer: C Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis.

Nurses in all settings need to prepare themselves to care for people with depression mainly for which of the following reasons? A. Nurses will have to treat many different forms of depression due to high stress jobs. B. Depression causes people to remain sicker longer. C. Depression will be a leading cause of disability by the year 2020. D. Nurses are responsible for reducing the incidence of depression.

Answer: C By 2020, major depressive disorder is projected to be the leading cause of disability in developed countries (Murray & Lopez, 1996).

Which client is most likely to receive opioids for extended periods of time? A: A client with fibromyalgia B: A client with phantom limb pain in the leg C: A client with progressive pancreatic cancer D: A client with trigeminal neuralgia

Answer: C Cancer pain generally worsens with disease progression, and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioids and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

Which method would a nurse use to determine a client's potential risk for suicide? A. Wait for the client to bring up the subject of suicide. B. Observe the client's behavior for cues of suicide ideation. C. Question the client directly about suicidal thoughts. D. Question the client about future plans.

Answer: C Directly questioning a client about suicide is important to determine suicide risk. The client may not bring up this subject for several reasons, including guilt regarding suicide, wishing not to be discovered, and his lack of trust in staff. Behavioral cues are important, but direct questioning is essential to determine suicide risk. Indirect questions convey to the client that the nurse is not comfortable with the subject of suicide and, therefore, the client may be reluctant to discuss the topic.

A 16-year-old girl has retuned home following hospitalization for treatment of anorexia nervosa. The parents tell the family nurse performing a home visit that their child has always done everything to please them and they cannot understand her current stubbornness about eating. The nurse analyzes the family situation and determines it is characteristic of which relationship style? a. Differentiation b. Disengagement c. Enmeshment d. Scapegoating

Answer: C Enmeshment is a fusion or overinvolvement among family members whereby the expectation exists that all members think and act alike. The child who always acts to please her parents is an example of how enmeshment affects development in many cases, a child who develops anorexia nervosa exerts control only in the area of eating behavior. The remaining options are not appropriate to the situation described.

What is the medical term for the red blood cell? A. Eosinophil B. Lymphocyte C. Erythrocyte D. Leukocyte

Answer: C Erythrocyte

Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral therapy unit? A. Emphasize the importance of good nutrition to establish normal weight. B. Ignore the client's mealtime behavior and focus instead on issues of dependence and independence. C. Help establish a plan using privileges and restrictions based on compliance with refeeding. D. Teach the client information about the long-term physical consequence of anorexia.

Answer: C Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished through behavioral therapy, which uses a system of rewards and reinforcements to assist in establishing weight restoration. Emphasizing nutrition and teaching the client about the long-term physical consequences of anorexia maybe appropriate at a later time in the treatment program. The nurse needs to assess the client's mealtime behavior continually to evaluate treatment effectiveness.

An elderly client with Alzheimer's disease becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to: a. Tell the client family that it is time to get dressed. b. Obtain assistance to restrain the client for safety. c. Remain calm and talk quietly to the client. d. Call the doctor and request an order for sedation.

Answer: C Maintaining a calm approach when intervening with an agitated client is extremely important. Telling the client firmly that it is time to get dressed may increase his agitation, especially if the nurse touches him. Restraints are a last resort to ensure client safety and are inappropriate in this situation. Sedation should be avoided, if possible, because it will interfere with CNS functioning and may contribute to the client's confusion.

What is the medical term for the membranes that cover the brain and spinal cord? A. Myasthenia B. Meningitis C. Meninges D. Cerebrospinal fluid

Answer: C Meninges

According to Piaget a 5 year old is in what stage of development: A. Sensory motor stage B. Concrete operations C. Pre-operational D. Formal operation

Answer: C Pre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A. Sensory-motor stage (0-2 years) is the stage when the child uses the senses in learning about the self and the environment through exploration. B. Concrete operations (7-12 years) when inductive reasoning develops. D. Formal operations (2 till adulthood) is when abstract thinking and deductive reasoning develop.

Primary level of prevention is exemplified by: A. Helping the client resume self care. B. Ensuring the safety of a suicidal client in the institution. C. Teaching the client stress management techniques D. Case finding and surveillance in the community

Answer: C Primary level of prevention refers to the promotion of mental health and prevention of mental illness. This can be achieved by rendering health teachings such as modifying ones responses to stress. A. This is tertiary level of prevention that deals with rehabilitation. B and D. Secondary level of prevention which involves reduction of actual illness through early detection and treatment of illness.

A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using? A. Displacement B. Projection C. Rationalization D. Sublimation

Answer: C Rationalization is the defense mechanism that involves offering excuses for maladaptive behavior. The client is defending his substance abuse by providing reasons related to life stressors. This is a common defense mechanism used by clients with substance abuse problems. None of the remaining defense mechanisms involves making excuses for behaviors.

The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication is labeled haloperidol 10 mg/2 ml. The nurse prepares the correct dose by drawing up how many milliliters in the syringe? A. 0.3 B. 0.4 C. 0.5 D. 0.6

Answer: C Set up the problem as follows: 2.5mg/10mg = Xml/2ml X=0.5ml

In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called: a. Aphasia b. Agnosia c. Sundowning d. Confabulation

Answer: C Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder. The other options are incorrect responses, although all may be seen in this client.

A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe

Answer: C The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

Which nursing intervention is most appropriate for a client with Alzheimer's disease who has frequent episodes emotional lability? A. Attempt humor to alter the client mood. B. Explore reasons for the client's altered mood. C. Reduce environmental stimuli to redirect the client's attention. D. Use logic to point out reality aspects.

Answer: C The client with Alzheimer's disease can have frequent episode of labile mood, which can best be handled by decreasing a stimulating environment and redirecting the client's attention. An over stimulating environment may cause the labile mood, which will be difficult for the client to understand. The client with Alzheimer's disease loses the cognitive ability to respond to either humor or logic. The client lacks any insight into his or her own behavior and therefore will be unaware of any causative factors.

The school guidance counselor refers a family with an 8-year-old child to the mental health clinic because of the child's frequent fighting in school and truancy. Which of the following data would be a priority to the nurse doing the initial family assessment? a. The child's performance in school b. Family education and work history c. The family's perception of the current problem d. The teacher's attempts to solve the problem

Answer: C The family's perception of the problem is essential because change in any one part of a family system affects all other parts and the system as a whole. Each member of the family has been affected by the current problems related to the school system and the nurse would be interested in the data. The child's performance in school and the teacher's attempts to solve the problem are relevant and may be assessed; however, priority would be given to the family's perception of the problem. The family education and work history may be relevant, but are not a priority.

The nurse enters the room of a client with a cognitive impairment disorder and asks what day of the week it is: what the date, month, and year are; and where the client is. The nurse is attempting to assess: A. Confabulation B. Delirium C. Orientation D. Perseveration

Answer: C The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time, place, and person). The nurse may also assess for confabulation and perseveration in a client with cognitive impairment; but the questions in this situation would not elicit the symptom response. Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis.

Which factors are most essential for the nurse to assess when providing crisis intervention foe a client? A. The client's communication and coping skills B. The client's anxiety level and ability to express feelings C. The client's perception of the triggering event and availability of situational supports D. The client's use of reality testing and level of depression

Answer: C The most important factors to determine in this situations are the client's perception of the crisis event and the availability of support (including family and friends) to provide basic needs. Although the nurse should assess the other factors, they are not as essential as determining why the client considers this a crisis and whether he can meet his present needs.

A client tells a nurse. "Everyone would be better off if I wasn't alive." Which nursing diagnosis would be made based on this statement? A. Disturbed thought processes B. Ineffective coping C. Risk for self-directed violence D. Impaired social interaction

Answer: C The nurse should take any nurse statements indicating suicidal thoughts seriously and further assess for other risk factors. The remaining diagnoses fail to address the seriousness of the client's statement.

The primary nursing intervention for a victim of child abuse is: A. Assess the scope of the problem B. Analyze the family dynamics C. Ensure the safety of the victim D. Teach the victim coping skills

Answer: C The priority consideration is the safety of the victim. Attend to the physical injuries to ensure the physiologic safety and integrity of the child. Reporting suspected case of abuse may deter recurrence of abuse. A,B and D may be addressed later.

The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which medications should she instruct the clients to avoid because of the increased risk of lithium toxicity? A. Antacids B. Antibiotics C. Diuretics D. Hypoglycemic agents

Answer: C The use of diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity. Clients taking lithium carbonate should be taught to increase their fluid intake and to maintain normal intake of sodium. Concurrent use of any of the remaining medications will not increase the risk of lithium toxicity.

The nurse is administering a psychotropic drug to an elderly client who has history of benign prostatic hypertrophy. It is most important for the nurse to teach this client to: A. Add fiber to his diet. B. Exercise on a regular basis. C. Report incomplete bladder emptying D. Take the prescribed dose at bedtime.

Answer: C Urinary retention is a common anticholinergic side effect of psychotic medications, and the client with benign prostatic hypertrophy would have increased risk for this problem. Adding fiber to one's diet and exercising regularly are measures to counteract another anticholinergic effect, constipation. Depending on the specific medication and how it is prescribed, taking the medication at night may or may not be important. However, it would have nothing to do with urinary retention in this client.

A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis? A. Anxiety B. Impaired social interaction C. Disturbed sensory-perceptual alteration (auditory) D. Risk for other-directed violence

Answer: D A client with these symptoms would have poor impulse control and would therefore be prone to acting-out behavior that may be harmful to either himself or others. All of the remaining nursing diagnoses may apply to the client with mania; however, the priority diagnosis would be risk for violence.

What is the medical term for disease of the heart muscle? A. Cardiopathy B. Cardioplexy C. Myopathy D. Cardiomyopathy

Answer: D Cardiomyopathy

A 75-year-old client has dementia of the Alzheimer's type and confabulates. The nurse understands that this client: a. Denies confusion by being jovial. b. Pretends to be someone else. c. Rationalizes various behaviors. d. Fills in memory gaps with fantasy.

Answer: D Confabulation is a communication device used by patients with dementia to compensate for memory gaps. The remaining answer choices are incorrect.

The nurse considers a client's response to crisis intervention successful if the client: A. Changes coping skills and behavioral patterns. B. Develops insight into reasons why the crisis occurred. C. Learns to relate better to others. D. Returns to his previous level of functioning.

Answer: D Crisis intervention is based on the idea that a crisis is a disturbance in homeostasis (steady state). The goal is to help the client return to a previous level of equilibrium in functioning. The remaining answer choices are not considered the primary outcome of crisis intervention, although they may occur as a side benefit.

What is the medical term for bluish discoloration of the skin? A. Cilium B. Effusion C. Edema D. Cyanosis

Answer: D Cyanosis

The emergency department nurse is assigned to provide care for a victim of a sexual assault. When following legal and agency guidelines, which intervention is most important? A. Determine the assailant's identity. B. Preserve the client's privacy. C. Identify the extent of injury. D. Ensure an unbroken chain of evidence.

Answer: D Establishing an unbroken chain of evidence is essential in order to ensure that the prosecution of the perpetrator can occur. The nurse will also need to preserve the client's privacy and identify the extent of injury. However, it is essential that the nurse follow legal and agency guidelines for preserving evidence. Identifying the assailant is the job of law enforcement, not the nurse.

What is the medical term for someone with protrusion of the eyeballs? A. Exotropia B. Opacification C. Ophthalmus D. Exophthalmos

Answer: D Exophthalmos

Which of the following outcome criteria is appropriate for the client with dementia? a. The client will return to an adequate level of self-functioning. b. The client will learn new coping mechanisms to handle anxiety. c. The client will seek out resources in the community for support. d. The client will follow an establishing schedule for activities of daily living.

Answer: D Following established activity schedules is a realistic expectation for clients with dementia. All of the remaining outcome statements require a higher level of cognitive ability than can be realistically expected of clients with this disorder.

What is the medical term for an accumulation of blood in a joint. A. Hematosis B. Hepatitis C. Hematuria D. Hemarthrosis

Answer: D Hemarthrosis

Which of the following statements by a client indicate that he or she has insight? A. "The nurses need to treat me better because I deserve better treatment." B. "I really do not need treatment. I am here because my mother signed me in." C. "The patients here are not as crazy or as stupid as the staff members are." D. "The medication makes me gain weight, but I take it to even my moods."

Answer: D Insight, or self-understanding, is important because it allows people to see their own motivations or reasons behind their feelings and behavior. A person lacking insight might refuse to take a medication because it causes his mouth to be dry. With insight a person could decide that even though he does not like to take the medication it helps his mental illness, so he will take it. Insight is critical for problem solving. Without it people often do not realize that they have a mental illness.

What is the medical term for surgical transplant of the cornea? A. Corneoplasty B. Keratonomy C. Keratoscopy D. Keratoplasty

Answer: D Keratoplasty

What is the medical term for disease of a lymph node? A. Adenectomy B. Adenitis C. Adenoidopathy D. Lymphadenopathy

Answer: D Lymphadenopathy

What is the medical term for inflammation of the tympanic membrane? A. Anotia B. Labyrinthitis C. Meniere's disease D. Myringitis

Answer: D Myringitis

What is the medical term for a woman who has never been pregnant? A. Nullipara B. Primipara C. Primigravida D. Nulligravida

Answer: D Nulligravida

Which of the following will the nurse use when communicating with a client who has a cognitive impairment? A. Complete explanations with multiple details B. Picture or gestures instead of words C. Stimulating words and phrases to capture the client's attention D. Short words and simple sentences

Answer: D Short words and simple sentence minimize client confusion and enhance communication. Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension. Although pictures and gestures may be helpful, they would not substitute for verbal communication.

Which factor is least important in the decision regarding whether a victim of family violence can safely remain in the home? A. The availability of appropriate community shelters B. The nonabusing caretaker's ability to intervene on the client's behalf C. The client's possible response to relocation D. The family's socioeconomic status

Answer: D Socioeconomic status is not a reliable predictor of abuse in the home, so it would be the least important consideration in deciding issues of safety for the victim of family violence. The availability of appropriate community shelters and the ability of the nonabusing caretaker to intervene on the client's behalf are important factors when making safety decisions. The client's response to possible relocation (if the client is a competent adult) would be the most important factor to consider; feelings of empowerment and being treated as a competent person can help a client feel less like a victim.

The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child

Answer: D The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.

The following are appropriate nursing diagnosis for the client EXCEPT: A. Ineffective individual coping B. Alteration in comfort, pain C. Altered role performance D. Impaired social interaction

Answer: D The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain.

The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse most likely establish in this situation? A. The client will recognize signs and symptoms of physical illness. B. The client will cope with physical illness. C. The client will take prescribed medications. D. The client will express anxiety verbally rather than through physical symptoms.

Answer: D The client with a somatoform disorder displaces anxiety onto physical symptoms. The ability to express anxiety verbally indicates a positive change toward improved health. The remaining responses do not indicate any positive change toward increased coping with anxiety.

The superego is that part of the psyche that: A. Uses defensive function for protection. B. Is impulsive and without morals. C. Determines the circumstances before making decisions. D. The censoring portion of the mind.

Answer: D The critical censoring portion of one's personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The Id is composed of the untamed, primitive drives and impulses. C. This refers to the ego that acts as the moderator of the struggle between the id and the superego.

The nurse is interacting with a family consisting of a mother, a father, and a hospitalized adolescent who has a diagnosis of alcohol abuse. The nurse analyzes the situation and agrees with the adolescent's view about family rules. Which intervention is most appropriate? a. The nurse should align with the adolescent, who is the family scapegoat. b. The nurse should encourage the parents to adopt more realistic rules. c. The nurse should encourage the adolescent to comply with parental rules. d. The nurse should remain objective and encourage mutual negotiation of issues.

Answer: D The nurse who wishes to be helpful to the entire family must remain neutral. Taking sides in a conflict situation in a family will not encourage negotiation, which is important for problem resolution. If the nurse aligned with the adolescent, then the nurse would be blaming the parents for the child's current problem; this would not help the family's situation. Learning to negotiate conflict is a function of a healthy family. Encouraging the parents to adopt more realistic rules or the adolescent to comply with parental rules does not give the family an opportunity to try to resolve problems on their own.

Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia? A. Symptoms of this disease imbalance in the brain. B. Genetic history is an important factor related to the development of schizophrenia. C. Schizophrenia is a serious disease affecting every aspect of a person's functioning. D. The distressing symptoms of this disorder can respond to treatment with medications.

Answer: D This statement provides accurate information and an element of hope for the family of a schizophrenic client. Although the remaining statements are true, they do not provide the empathic response the family needs after just learning about the diagnosis. These facts can become part of the ongoing teaching.

Which of these is an infection with the fungus Candida. A. Titer B. Impetigo C. Macrophage D. Thrush

Answer: D Thrush